Endotoxins do not influence transplacental transmission of lymphotropic human herpesviruses and human papillomaviruses into amniotic fluid taken from healthy mothers before parturition in Hungary.

Pregnant women were examined following healthy pregnancies at term. Amniotic fluids were sampled before arteficial rupture of membranes using closed vacutainer system. Blood samples were also taken from the pregnants simultaneously. Endotoxin concentrations of amniotic fluids were tested by the semiquantitative Limulus amebocyte lysate. Both amniotic fluids and blood samples were tested for the presence of DNA of lymphotropic human herpesviruses. The DNA of human papillomaviruses were tested only in the amniotic fluid samples. One-third of the amniotic fluids tested were found to contain measurable amounts of endotoxin. Lymphotropic herpesvirus DNA was deteced in every fourth amniotic fluid sample and in every 8th blood sample. The prevalence of papillomaviruses was 7 of 96 samples. No significant correlation was found between the presence of endotoxin and viruses in the amniotic fluids. Epstein-Barr virus, human cytomegalovirus and human herpesvirus type 7 were found more frequently in the amniotic fluids than in blood samples (7 to 1). The prevalence of human herpesvirus 6 and 8 was higher in the blood samples than that in the amniotic fluids. The mean weight of the neonates were not impaired significantly by the presence of either viruses or endotoxin. Possible post partum consequences, i.e. partial immunotolerance to viruses is discussed.

Screening for human papillomavirus infection in asymptomatic women in Hungary.

BACKGROUND: A multicentre epidemiological survey was carried out in order to determine the prevalence of, and risk factors for, persistent cervical human papillomavirus (HPV) infection in women in Hungary. METHODS AND RESULTS: A total of 728 women were examined for the prevalence of HPV. The estimated overall rate of HPV infection was 17%. In univariate analysis the strongest predictors were young age (< or =24 years), unmarried family status, smoking, a pathological Papanicolaou (Pap) smear, having a condyloma and previous gynaecological cancer in the family (age and marital status being the most important predictors). In multiple regression analysis, young age (< or =24 years)(odds ratio = 1.86, 95% confidence interval = 1.19-2.90, P < 0.01), smoking (1.78, 1.17-2.71, P < 0.05), an abnormal Pap smear (6.92, 2.68-17.84, P < 0.001), having a condyloma (4.22, 1.42-12.58, P < 0.01) and living in a region where the unemployment rate is relatively high (1.56, 1.24-2.82, P < 0.01) were associated risk factors for HPV infection. CONCLUSIONS: The prevalence of HPV infection in young women in Hungary is high. Screening for HPV is suggested only in women with an unfavourable gynaecological history who are < or =24 years old.

[Detection of human papillomavirus infection by the nucleic acid hybridization method (a multicenter study)]. / Human papillomavírus-fertözés kimutatás nukleinsav hibridizációs módszerrel (multicentrikus tanulmány).

The human papillomaviruses (HPV) are regarded as one of the important agents of cervical carcinoma. A multicentre study was organized to determine the prevalence of HPV in the fertile female population in Hungary. Parallel with the clinical sample collection, a questionnaire interview was performed to acquire data on the life style, socioeconomic status, sexual practice, etc. 1200 women were examined colposcopically and cervix samples were collected for cytology and the detection of HPV DNA. 17.4% of the samples were HPV-infected. 3.9% of the patients had acquired low-risk, and 10.1% 10.2% high-risk HPV types; 3.4% of the women were at the same time infected with both low-risk and high-risk HPV types. Simultaneously performance of cytology and the HPV hybrid capture assay contribute to recognise and treat the precancerous status and risk factors.

c-myc, c-erbB-2, c-fms and bcl-2 oncoproteins. Expression in normal placenta, partial and complete mole, and choriocarcinoma.

OBJECTIVE: To determine the expression of bcl-2, c-myc, c-fms and c-erbB-2 oncoproteins in normal placentas, partial and complete hydatidiform moles, and choriocarcinomas and to examine the possible presence of mutations in the K-ras gene in complete moles and choriocarcinomas. STUDY DESIGN: The expression of the above oncoproteins was determined immunohistochemically by specific antibodies for these proteins on formalin-fixed paraffin sections of 18 normal placentas, 17 partial moles, 25 complete moles and 11 choriocarcinomas. This was followed by polymerase chain reaction analysis (exons 12 and 13) of K-ras gene for possible mutations in complete moles and choriocarcinomas. RESULTS: Expression of c-fms oncoprotein appeared confined to the cytoplasm of syncytiotrophoblastic cells. The c-fms protein staining intensity of the syncytiotrophoblastic layer showed no significant difference among the four gestational tissues. c-erbB-2 antibody expression was confined to the cellular membrane of the extravillous trophoblast. When compared with normal placenta or partial mole, the expression of c-erbB-2 protein was significantly stronger in complete mole (P < .0001 and P < .0001, respectively) and choriocarcinoma (P < .0001 and P < .0001, respectively). Expression of bcl-2 protein was significantly stronger in the syncytiotrophoblast in complete mole and choriocarcinoma as compared to both normal placenta and partial mole (P < .0001 and P < .0001, respectively). Staining of c-myc of the syncytiotrophoblastic layer was significantly stronger in placenta, complete mole and choriocarcinoma than in partial mole (P < .0001, P < .0001 and P < .0001, respectively). Mutation in K-ras gene was not found in any of the 22 complete moles or 11 choriocarcinomas examined. CONCLUSION: Our data suggest that c-myc, c-erbB-2, c-fms and bcl-2 oncoproteins may be important in the pathogenesis of complete mole and choriocarcinoma. However, while both complete mole and choriocarcinoma were characterized by overexpression of c-myc, c-erbB-2 and bcl-2, partial mole generally did not strongly express these three oncoproteins.

Effect of superovulation combination therapy containing Clostilbegyt (clomiphene citrate) on follicular development and the endometrium.

The effect of Clostilbegyt + Humegon + Pregnyl ovulation inductive combination therapy was examined in the woman members of 20 sterile couples appearing at the Outpatient Department of Cryospermatology, Department of Obstetrics and Gynaecology Postgraduate Medical School. In 18 of the 20 cases follicle maturation and ovulation could be induced. In the male members of the couples therapy-resistant sterility existed at the same. By using artificial insemination by donors with cryopreserved sperms, gravidity could be obtained in 14 cases. The importance of the optimal timing of AID has been emphasized. In the course of transvaginal ultrasonography folliculometry was completed with the control of the pre-ovulatory changes of the endometrium. The appearance of the pre-ovulatory ring preceded the occurrence of pregnancy in all cases, being a sign of predictive value considering conception.

Examination of the follicular maturation influencing effect of Clostilbegyt by endocrinous and electronic monitoring.

The follicle maturation influencing effect of Clostilbegyt (50 mg Clomiphene-citrat) has been examined in 30 women suffering from primary or secondary sterility. For monitoring follicular development a vaginal ultrasound scanner was used. The development of yellow body and its adequate function have been controlled with serum progesterone determination. In the first therapeutical cycle daily 1 tbl. Clostilbegyt was used from the 4th day of the menstruation in a five day period. In the next cycle daily 2 tbl. were administered similarly. If the therapy was unsuccessful, then 3 tbl. per day Clostilbegyt was used as treatment in the 3rd cycle. In the course of monitoring with vaginal ultrasound scanner successful ovulation induction has been proved in 80% of the Clostilbegyt treated cases (in 24 of 30 cases). During the examination period pregnancy occurred in 7 cases (29.2%). Vaginal ultrasound monitoring is recommended by the author for ovulation induction therapy.

[Significance of the determination of estrogen and progesterone receptors in trophoblast diseases]. / Die Bedeutung der Bestimmung von Estrogen- und Progesteronrezeptoren bei Trophoblasterkrankungen.

Binding capacity (Bmax) and affinity (Kd) of cytoplasmatic estradiol and progesteron receptors were determined in trophoblastic tissue and in decidual endometrium by the authors. Results in normal and pathological endometrium and in mature placenta tissue were compared. Both estrogen and progesteron receptors were proved to exist in the decidual endometrium nearest to the molar tissue. Their binding parameters are similar to those in normal endometrium. No progesterone receptors were found in the molar tissue. Binding capacity of estrogens were found to be similar to that of the normal mature placenta. The lack of progesterone receptors might be an etiological factor in the pathogenesis of trophoblast diseases.

Release of prostacyclin (PGI2) from trophoblast in tissue culture: the effect of glucose concentration.

It is known that short term cell culture system offers a reliable and reproducible means for measuring placental PGI2 production in vitro, in which factors controlling its production and metabolism can be studied. The aim of the present investigation was to study the effect of glucose on generation of PGI2 by trophoblast obtained from early pregnancy in short term cell culture. Trophoblast was cultured using the method of Jogee et al and the concentration of 6-oxo-PGF1 alpha in culture supernatans was measured by a specific direct radioimmunoassay (New England Nuclear, USA). There was a significant decrease in 6-oxo-PGF1 alpha production by trophoblast cells when incubating with increased glucose concentrations (300 and 600 mg/dl) compared to controls (without glucose). These data show for the first time that high concentrations of glucose inhibit PGI2 production by cultured trophoblast cells obtained from early pregnancy. The implication of these findings for the mechanism of development of congenital anomalies in diabetic pregnant women is discussed.

Maternal perception, tocodynamometric findings and real-time ultrasound assessment of total fetal activity.

"Total" fetal motor activity was determined in 111 healthy patients between 25 weeks of pregnancy and term using two real-time ultrasound devices simultaneously. Furthermore tocographic findings and also maternal perception of fetal movements of the same patients were stored synchronously on magnetic tape. A comparison was drawn between these three methods, i.e. real-time ultrasonography, maternal perception and tocographic tracings ("spikes" indicating fetal movements). Of all fetal movements, as assessed by real-time ultrasonography, the mothers perceived a total of 38% whereas "spikes" in tocographic tracings corresponded with fetal motor activity (excluding "breathing") in only 25% of the cases (P less than 0.001). Also major statistically significant differences could be found between maternal perception of fetal body movements with or without fetal limb movements in 56% and routine- tocography in 37% (P less than 0.001). Also isolated limb movements were most often detected by mothers (23%) than were revealed by tocographic findings (14%; P less than 0.001). Maternal signals were truly positive in 74% compared to tocography in only 56% of the cases (P less than 0.001). It is concluded that maternal perception of fetal movements is a more reliable method of monitoring fetal motor activity than analysis of tocographic tracings.

Maternal perception of fetal movements and real-time ultrasound findings.

Two real-time ultrasound instruments were used simultaneously for comprehensive recording of "total" fetal motor activity in 50 patients in the second half of pregnancy. Synchronously, cardiotocographic findings and maternal perception of fetal movements were stored on magnetic tape. In most cases fetal "gross" movements were perceived by the mothers (mean: 63%). Isolated movements of fetal extremities were reported by the mother in only about 15% of all cases. Mothers registered a total of all movements in 37%. We found a statistically significant difference in the percentage of perceived fetal movements with regard to parity (p less than 0.001) and with regard to gestational age (p less than 0.01). With multiparity or an increasing gestational age the body movements of the fetuses were felt more accurately by the mothers. In 30% of all cases the mothers perceived movements without sonographic confirmation. The findings of this study suggest that maternal perception of major fetal body movements is accurate in the majority of cases. However, the relatively high rate of false positive maternal perception should be taken into consideration if the maternal record of daily fetal movements is to be used for fetal monitoring.

[Zinc levels of maternal serum and umbilical venous blood in normal, small-for-gestational age and large-for-gestational-age infants]. / Der Zinkgehalt im mütterlichen Serum und Nabelvenenblut bei norm-gewichtigen Neugeborenen, bei small-for-dates and large-for-dates.

The zinc concentration of the cord blood was measured in several thousand cases. 482 pregnant women were randomised and evaluated right after the delivery. The newborn's weight were normal in 241 cases, while 241 mothers delivered intrauterine retarded babys. The zinc concentration of the sera was significantly higher in this second group. Following the maternal serum zinc measurement the cord blood zinc concentration was established in 182 cases. The zinc content of the 91 intrauterine retarded newborn's cord blood was significantly lower than in their maternal sera respectively comparing the normal newborns with the retarded newborns the maternal serum zinc concentration was higher than the cord blood's. The 59 large-for-dates newborns (higher than 4 000 g) and the 56 normal newborns showed no difference either in the maternal or in the cord blood zinc concentration.

[Detection of fetal movements in the tocogram]. / Die Erkennung von fetalen Bewegungen im Tokogramm.

The total fetal movement activity was determined in 111 pregnant patients from 24 weeks to 42 weeks by simultaneous real-time ultrasonography and tocodynamometry. A comparison of the methods of investigation showed that tocodynamometry only detects 37% of all fetal movements with or without movements of the extremities. Movements of the extremities were only recorded in 14% of the cases. A total of only 25% of all fetal movements showed "spikes" in the tocogram. Of all the recorded spikes only 56% corresponded to a fetal movement, whereas 44% of the spikes in the tocogram were false-positive. These data demonstrate that routine clinical cardiotocography has a limited value only in the monitoring of fetal movement activity.

[Fetal motor activity and acceleration in the cardiotocogram]. / Fetale Bewegungsaktivität und Akzelerationen im CTG.

The results of the concomitant monitoring of the fetal heart rate and the total fetal movement activity by two ultrasound monitors are reported. In 111 patients from 26 weeks gestation to term the cardiotocogram and the fetal movement activity were at the same time monitored with two ultrasound monitors. In total 453 fetal heart rate accelerations of more than 15 beats per minute and more than 15 seconds duration were found in all cardiotocograms. The most frequent finding with an acceleration of the fetal heart rate were fetal body movements with or without movements of the extremities in 71% of the fetal heart rate accelerations. In 18% of the fetal heart rate accelerations movements of the fetal extremities were found by ultrasonography. In 7% of the fetal heart rate accelerations, fetal respiratory movements or contractions were found without fetal body movements. 4% of the fetal heart rate accelerations occurred without sonographically or topographically recognizable cause. In all ultrasonographically recognized fetal movements of the body and/or the extremities the fetal heart rate accelerations occurred in 28% of the cases. The most frequent findings were movements of the fetal body with or without movements of the fetal extremities in 48% of the fetal heart rate accelerations. In isolated movements of the fetal extremeties the fetal heart rate was only accelerated in 11% of the cases.

[The maternal perception of fetal movements during the last trimester of pregnancy]. / Die mütterliche Perzeption fetaler Bewegungen im letzten Schwangerschaftsdrittel.

In a prospective study the foetal movements were simultaneously registered with two real time ultra-sound instruments and compared with the maternal perception of the movements. 35 patients were studied with a mean investigation time of 20 minutes per patient. The mothers pushed a button when they perceived a movements. Synchronous to this registration and storage on a tape were done of the movements of the upper and lower extremities the body movements and the foetal respiratory movements, the foetal heart rate and the uterine contractions. The mothers noticed a total of 38% of all foetal movements. Most frequently the mother noticed in 78% of the cases total foetal movements of the body and extremities. Isolated movements of the foetal body without movements of the extremities were only perceived by the mothers in 31% of the cases and isolated movements of the extremities were only perceived in 15%. In 69% of the cases the mothers correctly indicated that foetal movement took place. In 31% of all maternal signals there was no sonographic evidence of foetal movements of the body or the extremities. In 24% of these cases foetal respiratory movements were evident and in 23% of the cases Braxton-Hicks contractions were found. In 54% of these cases the signal button was used by the mothers without detectable reason. This high failure rate of maternal perception of foetal movements needs to be considered in the evaluation of foetal movements by the mother.